Free Insurance Licensing Virginia-Life-Annuities-and-Health-Insurance Practice Exam with Questions & Answers | Set: 13

Virginia Code § 38.2-3501 requires individual health insurance policies to incorporate the application as part of the contract, as it contains critical personal data (e.g., name, age, medical history) used to determine insurability (option C). This document—completed by the applicant and agent—details health conditions, lifestyle factors (e.g., smoking), and other risk indicators the underwriter evaluates—e.g., a 30-year-old with asthma noted for rating. Option A (enrollment form) applies to group health plans, not individual policies, where employees join a pre-set plan. Option B (policy schedule) summarizes coverage (e.g., limits, premiums) after issuance, not initial data for underwriting. Option D (agent’s statement) may supplement the application with observations, but it’s not the primary source; the application itself holds the insured’s data. The study guide likely highlights the application’s role in a health insurance section, with examples—e.g., a question about prior hospitalizations triggering a premium adjustment—making C the key document, per Virginia’s legal requirement that it be attached to the policy (§ 38.2-3503) for transparency and enforceability.

The fixed-period installment option provides that the death benefit proceeds, together with interest, are paid in equal installments to the beneficiary over a specified number of years. Each installment consists of principal and interest until the proceeds are fully distributed at the end of the fixed period. This ensures a guaranteed stream of income for the chosen period regardless of when the proceeds are exhausted.

Exact Extract (Virginia Life & Annuities Study Guide): “Settlement options include: fixed-period installments—payment of proceeds in equal installments over a specified period of years, consisting of principal and interest.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Section 5.3 Settlement Options

— Code of Virginia §38.2-3117.2 (Requirement to provide settlement option explanations to beneficiaries)

A POS plan blends characteristics of HMOs and PPOs/indemnity plans. Like an HMO, members choose a primary care physician, but they can also go out-of-network and receive partial reimbursement (similar to indemnity coverage). Exact extract: “POS plans combine features of HMOs and indemnity plans, permitting members to seek care within the network or outside the network at higher cost-sharing.” This flexibility allows broader provider choice while controlling costs through the HMO model.

Under Virginia licensing standards and federal tax principles taught for the life insurance exam, life insurance death proceeds are generally exempt from federal income tax when paid to a beneficiary due to the insured’s death. This long-standing rule is a fundamental advantage of life insurance and is frequently tested.

The transfer-for-value rule applies only in limited situations when a life insurance policy is sold or transferred for consideration, which is not the general rule for death benefits. The cost recovery rule and interest-first rule apply to annuities, not life insurance death proceeds. Therefore, options B, C, and D are incorrect.

This tax-free treatment allows beneficiaries to receive the full face amount without reduction for income taxes, making life insurance an effective financial protection and estate planning tool. While estate taxes may apply in certain high-value estates, income tax treatment remains favorable in most cases.

Business overhead expense insurance is designed to cover the fixed business expenses, such as rent, utilities, and employee salaries, if the business owner becomes disabled and cannot work. This insurance ensures that the business can continue to operate in the owner's absence, covering regular business expenses but not providing a direct income replacement to the business owner.

Virginia Code § 38.2-3432.1, aligned with the Affordable Care Act (ACA), mandates guaranteed renewability for small employer health plans (1-50 employees in Virginia). Insurers can deny renewal for nonpayment of premiums (option A), insufficient participants (option B, e.g., falling below one eligible employee), or fraud (option D), per Virginia Code § 38.2-3407. However, option C—overuse of services (high claims)—a—is not a permissible reason for denial, as renewability cannot be based on claims experience or health status. The study guide emphasizes this protection under Virginia’s small group market rules, making C the exception.

A preferred risk classification is typically available for life insurance applicants who have a better-than-average life expectancy. These individuals are generally in excellent health, have no significant medical issues, and engage in behaviors that reduce health risks, such as non-smoking. Applicants in this category are eligible for lower premiums because they are considered lower risk.

Insurers may consider objective risk-related factors such as age, gender, health, and occupation when underwriting disability insurance. Religion, however, is not an allowable underwriting factor. Exact extract: “Underwriting criteria may not unfairly discriminate based on race, color, creed, or religion.” This prohibition ensures fair treatment of all applicants while still allowing actuarial factors like age and occupation to determine risk.

An application for individual health insurance must be in writing and becomes part of the insurance contract. The information provided in the application, along with any attachments, helps form the basis of the policy. If any statements or answers in the application are found to be false or misrepresented, the insurer may have grounds for denying a claim.

“Conditionally renewable” policies guarantee renewal as long as certain conditions listed in the contract are met. These conditions may include factors such as reaching a certain age or maintaining occupation class, but not health status or claims history. Exact extract: “A conditionally renewable policy may be nonrenewed only on grounds stated in the policy; health deterioration or claims experience may not be a reason for nonrenewal.” This gives insurers some flexibility while protecting consumers from arbitrary termination.